Sankofa Behavioral Health Services LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

SANKOFA BEHAVIORAL HEALTH SERVICES LLC

Practice address

5379 Lenox Ave
Jacksonville, FL 32205-4737

Phone

(904) 891-6614

Fax

(904) 512-6614

NPI assigned

Nov 10, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mia R Wilson, ED.DNPI 1912921743

Title

LMHC

Phone

(904) 891-6614

Specialties & licenses 2

Addresses

Other names 1

• Dr. Mia R. Wilson Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mia R Wilson, ED.D

  • Mental Health Counselor
  • Jacksonville, FL
  • NPI 1912921743
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1604966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604966400000",
    "number": "1710589205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8056",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322390056",
            "telephone_number": "904-891-6614",
            "fax_number": "904-512-6614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5379 LENOX AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322054737",
            "telephone_number": "904-891-6614",
            "fax_number": "904-512-6614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANKOFA BEHAVIORAL HEALTH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-10",
        "last_updated": "2020-11-10",
        "certification_date": "2020-11-10",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "MIA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "LMHC",
        "authorized_official_telephone_number": "904-891-6614",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "ED.D"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Mia R. Wilson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Martin C Sanguinette, LMT
• Srivani Sanikommu, M.D.
• Sanitas Systems, Inc
• Louis Sanjar, MD
• Jorge Marcelo Sanjines, ACNP
• Shalini Sanku
• Ina Michelle Sanson, PA-C
• Frank Santamaria, MD
• Claudia Marie Santana Quinonez, SA-C
• Jose A Santana, MD

• Adult Mental Health Clinic/Center in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Adult Mental Health Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.